Provider Demographics
NPI:1376372938
Name:CHICAGO NORTH SHORE THERAPY
Entity type:Organization
Organization Name:CHICAGO NORTH SHORE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:LESSACK
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, LCPC
Authorized Official - Phone:224-259-2271
Mailing Address - Street 1:PO BOX 6032
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60204-6032
Mailing Address - Country:US
Mailing Address - Phone:773-800-9763
Mailing Address - Fax:
Practice Address - Street 1:814 MICHIGAN AVE APT 2W
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2544
Practice Address - Country:US
Practice Address - Phone:570-417-7223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty